Interventional Procedures

Not everyone who has cardiac disease needs cardiac surgery. Our state-of-the-art cardiovascular catheterization laboratory, in which we perform interventional procedures, is the highest volume facility in Central New York, serving more than 5,000 patients annually.

Cardiac catheterization is one of the most useful and accurate tests to diagnose cardiovascular problems. It is used to determine the health of the coronary arteries, heart valves and heart muscle. It may also be used to treat heart conditions, such as narrowed heart valves and coronary arteries.

During a cardiac catheterization procedure, a small incision is made in the groin or arm. A long thin tube called a catheter is then inserted and then guided through the blood vessels to the heart. The procedure is usually performed while you’re awake, but you will be given medications to help you relax. An intravenous line will be inserted in your hand or arm, and will be used to give you any additional medications you might need during your procedure. Recovery time for a cardiac catheterization is quick, and there's usually a low risk of complications. Sometimes immediately following the diagnostic catheterization procedure, the operating physician may decide to perform angioplasty or a stent placement.

St. Joseph’s Hospital Health Center has been named one of America’s 100 Best Hospitals for Coronary Intervention by HealthGrades (2013) www.healthgrades.com, making it one of the top 10 percent in the nation.

Below you will find some of the most common interventional procedures we perform at St. Joseph's.

Procedures

Alcohol Septal Ablation for Hypertrophic Cardiomyopathy

Alcohol septal ablation (ASA) is a minimally-invasive treatment performed by an interventional cardiologist to relieve symptoms and improve functional status in patients with hypertrophic cardiomyopathy (HCM), or when the heart muscle which grows abnormally thick, causing the heart to lose its ability to pump blood effectively.

ASA is a technique designed to reduce the obstruction by creating a small controlled heart attack, killing the area of thickened heart muscle responsible for the obstruction, and eventually causing it to become less thick. Much like an angioplasty, a balloon catheter is inserted into the artery and inflated. A contrast agent is injected to locate the thickened septal wall that narrows the passageway from the left ventricle to the aorta. When the bulge is located, a tiny amount of pure alcohol is injected through the catheter (long, thin, hollow tube). The alcohol kills the cells on contact, causing the septum to shrink back to a more normal size over the following months, widening the passage for blood flow.

Angioplasty

To open arteries blocked by cholesterol (fatty deposits) and restore normal blood flow to the heart muscle, a procedure called angioplasty (also known as percutaneous coronary intervention -PCI) may be performed. Working through a tiny incision in the arm or leg, an interventional cardiologist threads a catheter (a long, thin, hollow tube) to the site of the blockage. A small balloon is then used to push plaque (caused by the buildup of cholesterol) against the wall of the artery and restore blood flow. Following angioplasty, a stent (a tiny, flexible mesh tube) may also be used to help keep the artery open and reduce the likelihood of another blockage.

Aortic Valvuloplasty

A heart with a narrowed valve cannot function as well as a normal heart and has difficulty pumping blood throughout the body. Valvuloplasty is used to stretch open the valves in those affected by a disease such as aortic stenosis.

Valvuloplasty uses a large balloon on a a thin, flexible tube (catheter) that is inserted through a large iv (arterial sheath) placed in the groin (femoral artery or vein). This balloon is places across the valve using X-ray guidance. When inflated, the balloon stretches the valve open. The balloon is then deflated and the catheter removed.

To place a stent in the carotid artery, angioplasty is used. Through a small incision in the groin, a special catheter (long, thin, hollow tube) with a tiny balloon at its tip is inserted into the carotid artery. The balloon is inflated once the catheter has been placed into the narrowed area of the carotid artery, compressing the fatty tissue in the artery and making a larger opening inside the artery for improved blood flow. A stent (a tiny mesh tube) is then inserted into the newly-opened area of the artery to help keep the artery from narrowing or closing again.Because of the potential for cholesterol and clots (emboli) to dislodge from the plaque into the blood leading to the brain and possibly cause a stroke, an embolic protection device (EPD) is typically used to catch and remove this debris.

Coronary Stent Placement

Not everyone who has heart disease needs cardiac surgery. Some patients may be candidates for insertion of a stent (a tiny mesh tube) during a procedure called angioplasty. A stent is used to hold open the arteries that feed oxygen-rich blood to the heart. Often angioplasty is performed to prepare the artery prior to stent placement.

Well-regarded in their field, St. Joseph’s interventional cardiologists participate in research involving cutting-edge technology. St. Joseph’s director of cardiac services and research Ronald Caputo, MD, recently reported on patient outcomes of a drug-eluting stent clinical trial.

A patent foramen ovale (PFO) and an atrial septal defect (ASD) are congenital (present at birth) structural heart diseases where blood is able to travel between the heart chambers. In case of an ASD, there is a permanent hole in the septum (dividing wall between the upper chambers), allowing blood to flow from the left to right atrium. This chronic volume overload causes dilatation of the right heart chambers and over time it may cause functional failure of the right heart. Contrary to the ASD, the PFO is not a hole, but an opening that acts like a door capable of allowing blood to pass from the right to the left side of the heart.

To close a PFO or ASD, a device closure procedure is used in the Cardiac Catheterization Lab. It involves slowly moving a catheter (a long, thin, flexible, hollow tube) into the heart, initially inserted into a large vein through a small incision in the groin area. The closure device, called a septal occludes, is moved through the catheter to the heart and to the location of the heart wall defect. Once in the correct location the device will remain in the heart permanently to stop the abnormal flow of blood between the two atrial chambers of the heart. The catheter is then removed and the procedure is complete.

Intracoronary echocardiography is used to provide physicians with images of the structures, including the chambers and valves, of the heart. High frequency sound waves are used to produce images, which are useful in the diagnosis of many types of cardiac disorders including valve, heart muscle and coronary artery disease, as well as determining the severity of the disease, if one is found.

A small high frequency ultrasound probe can also be placed inside the coronary arteries. This allows for measurement of blockage.

Percutaneous Coronary Interventions

Percutaneous coronary intervention (PCI), also referred to as percutaneous transluminal coronary angioplasty (PTCA), coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease . It is performed to open blocked coronary arteries and to restore blood flow to the heart tissue without open-heart surgery. A special catheter (long, thin, hollow tube) is inserted into the coronary artery to be treated. This catheter has a tiny balloon at its tip. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.

Pressure Wire

A thin (14/1000 of an inch in diameter) wire with a pressure transducer can be passed beyond blockages in coronary arteries to help measure blood flow. This helps the interventional cardiologist determine the amount of blood flow passing beyond the blockage and whether it is sufficient.

Renal Angioplasty & Stenting

Renal angioplasty and stenting treats renal artery stenosis (RAS), or the narrowing of one or both renal arteries (arteries that run to the kidneys). If untreated, RAS will lead to hypertension (high blood pressure) as the affected kidneys release renin to ensure they receive enough blood to preserve kidney functions.

Through a small incision in the groin, a special catheter (long, thin, hollow tube) with a tiny balloon at its tip is inserted into the renal artery. The balloon is inflated once the catheter has been placed into the narrowed area of the renal artery, compressing the fatty tissue in the artery and making a larger opening inside the artery for improved blood flow. A stent (a tiny mesh tube) may then be inserted into the newly-opened area of the artery to help keep the artery from narrowing or closing again. The catheter is then removed and the incision is closed.

Rotational Atherectomy

As a person ages, arteries may become blocked from a buildup of fatty deposits or cholesterol. A rotational atherectomy is an interventional coronary procedure that may be performed to help open them and restore blood flow to the heart.

During this procedure, a high speed rotational "burr" coated with hard microscopic diamond particles rotates at very high speeds, breaking up blockages into very small fragments that pass harmlessly into the blood stream. This is very helpful for treating hard and calcified blockages. Angioplasty and possible placement of a stent may be performed after rotational atherectomy to aid the results.

Thrombectomy

Atherosclerosis, the thickening and hardening of artieries due to the formation of plaque, may damage the inner lining of the arteries and lead to a blood clot (thrombosis) in a blood vessel. The clot obstructs blood flow, and may lead to a heart attack. A thrombectomy is performed to remove the clot and restore blood circulation. Depending on the size and location of the clot, the procedure differs slightly.